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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Peak Strain Dispersion: a new promising prognostic predictor early after STEMI
Session:
Sessão de Comunicações Orais - Imagem
Speaker:
João Pedro de Sousa Bispo
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João De Sousa Bispo; Pedro Oliveira De Azevedo; Pedro Freitas; Sara Borges; Gonçalo Lopes Da Cunha; Pedro Lopes ; Carla Reis; Eduarda Horta; Marisa Trabulo; João Abecasis; Manuel Canada; Regina Ribeiras; Maria João Andrade
Abstract
<p><strong>Background:</strong> Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation.</p> <p><strong>Objectives:</strong> To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI.</p> <p><strong>Methods:</strong> Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2016. Patients with poor acoustic windows, severe valvular disease, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at 3 years. Survival analysis was used to determine independent predictors of the primary endpoint.</p> <p><strong>Results:</strong> 248 patients were included, mean age 61 ± 14 years, 73% males. Mean LVEF was 49.8 ± 10.1% with 18% of patients having LVEF < 40%. Mean LAVi was 33 ± 10 ml/m<sup>2</sup>, mean GLS was -14 ± 4%, and PSD was 59 ± 21msec. Average follow-up was 40 ± 13 months, with a 3 year combined endpoint of mortality and hospitalization of 26% (n = 65)</p> <p>Univariate analysis revealead an association between LAVi, GLS and PSD and mortality or hospitalization. However, on multivariate analysis only LAVi (HR 1.02 - 1.08; p < 0.001) and PSD (HR 1.001 - 1.022; p = 0.045) remained independent predictors of the primary endpoint.</p> <p><strong>Conclusion:</strong> PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge.</p>
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